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November 4, 2008    DOL Home > ESA > OWCP > DFEC > Forms   

Office of Workers' Compensation Programs (OWCP)

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OWCP Administers disability compensation programs that provide benefits for certain workers or dependants who experience work-related injury or illness.
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Division of Federal Employees' Compensation (DFEC)


OWCP's Division of Federal Employees' Compensation has made a variety of forms available online. These forms are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.

The forms in the list below may be completed manually via the print form option or electronically via the electronic fill/submit option:

Printable Forms

All of DFEC's online forms are available to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Then mail or fax the completed form to the DFEC office you normally send to for this process.

Fillable Forms

Forms noted with an asterisk (*) may be electronically filled. Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature) and mail or fax the completed form to the DFEC office you normally send to for this process.

Submitable Forms

Select DFEC forms, noted with double asterisks (**) on the list of forms below, may be electronically filled and submitted to OWCP/DFEC. To do so, you must have Adobe Reader 6.x installed on your PC.

To electronically submit a DFEC form, follow these simple steps:

  1. Obtain an electronic signature from IdenTrust Inc. Upon opening the form, if you don't already have a digital signature on your PC, you will be directed to the IdenTrust Inc. website to obtain an electronic signature. The entire process of obtaining the electronic signature will take 5-10 business days.
    Note: Adobe 6.x is required to apply a digital signature

    (You only have to do this one time. Thereafter, you will use the same signature.)

  2. Fill out the form, making sure to fill in the required fields (marked with a red asterisk (*)). If you do not fill in all the required fields, you will not be able to submit the form.

    It is recommended that you print the form prior to submitting, and keep the hardcopy for your records. To do so, use the [Print] button provided near the top of the form.

  3. Click on the [Submit] button near the top of the form. A message will appear noting that the form has been received and will provide an identification number. It is recommended that you record the ID number on your hardcopy.

  4. If you have questions about filling/submitting these forms or need other forms assistance, you can send DFEC a question via e-mail by clicking DFEC-FormsAssistance. DFEC will respond to your question via e-mail.

NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.

Form Number

OWCP's Form Title / Description


Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation


Notice of Occupational Disease and Claim for Compensation


Notice of Recurrence


Claim for Compensation by Widow, Widower, and/or Children


Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren


Official Supervisor's Report of Employee's Death


Claim for Compensation

Form CA-7 replaces ALL prior versions of CA-7 & CA-8 (see FECA Bulletin No. 99-18)


Time Analysis Form, used for claiming compensation, including repurchase of paid leave


Leave Buy Back (LBB) Worksheet/Certification and Election


What A Federal Employee Should Do When Injured At Work


Claim For Continuance of Compensation Under the Federal Employees' Compensation Act


Duty Status Report


Attending Physician's Report


Evidence Required in Support of a Claim for Occupational Disease


Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act


Notice of Law Enforcement Officer's Injury Or Occupational Disease


Notice of Law Enforcement Officer's Death


Letter to Dependants to Verify Claimant Support


Letter to Parents in Death Claim Development


Statement of Recovery Letter with Long Form


Statement of Recovery Letter with Short Form


Claim for Reimbursement Assisted Reemployment


Work Capacity Evaluation Psychiatric/Psychological Conditions


Work Capacity Evaluation Cardiovascular/Pulmonary Conditions


Work Capacity Evaluation for Musculoskeletal Conditions


Rehabilitation Plan And Award


Rehabilitation Maintenance Certificate


Overpayment Recovery Questionnaire


Rehabilitation Action Report


Uniform Billing Form


Claim For Medical Reimbursement

Form OWCP-915 replaces CA-915


Medical Travel Refund Request


Provider Enrollment form


Health Insurance Claim Form


Health Insurance Claim Form


Phone Numbers